Coolspring Power Museum - Contribution Form

Coolspring Power Museum

Contribution Form

For those wishing to contribute without applying for membership in the museum's Friends Support Group

Company Name: ____________________________________	Phone: ______________________
Name: ____________________________________	E-mail: ______________________
Street: ____________________________________
City: ____________________________________
State: ____________ Country: ______________
ZIP code or International Code: ______________

Do you wish to have your contribution dedicated to a specific project or function at the museum? If so, please identify that project or function here: ______________________________________________________________________________________
_______________________________________________________________________________________

Amount of Contribution	$
Additional Amount for the General Operating Fund	$
Additional Amount for the M.A.N. Diesel Engine Fund	$
Additional Amount for the Endowment Fund	$
International Processing Fee*	$
Other	$
Total Enclosed	$

THANK YOU FOR YOUR CONTRIBUTION!
Send with remittance to:
Darlene Stuchell - Coolspring Power Museum Treasurer
76 Harvest Lane
Punxsutawney, PA 15767

The official registration and financial information of Coolspring Power Museum may be obtained from the Pennsylvania Department of State by calling toll-free, within Pennsylvania, 1-800-732-0999. Registration does not imply endorsement.

*International Contributors: Please add a $15 fee to cover the fee our bank charges
to process your non-US$ checks.